COUNTRYSIDE HOME - JEFFERSON, WI
United States hospital / nursing home:
COUNTRYSIDE HOME - JEFFERSON, WI
COUNTRYSIDE HOME
1425 WISCONSIN DR
JEFFERSON, WI 53549
RELIGIOUS NONMEDICAL HEALTH CARE INSTITUTIONS SNF/NF (DISTINCT PART)
Services provided by COUNTRYSIDE HOME:
- Activities services are provided onsite to residents
- Dental services are provided onsite to residents
- Dietary services are provided onsite to residents
- Housekeeping services are provided onsite to residents
- Mental health services are provided onsite to residents
- Nursing services are provided onsite to residents
- Occupational therapy services are provided onsite to residents
- Field 1 - Indicates other activity services provided by staff onsite to residents
- Pharmacy services are provided onsite to residents
- Physician extender services are provided onsite to residents
- Physical therapy services are provided onsite to residents
- Physician services are provided onsite to residents
- Podiatry services are provided onsite to residents
- Social work services are provided onsite to residents
- Speech/language pathology services are provided onsite to residents
- Therapeutic recreation specialist services are provided onsite to residents
- Diagnostic xray services are provided onsite to residents
Beds - Total (Total number of beds in a facility, including those in non-Participating or non-licensed areas): 206
Beds - Total certified (Number of beds in Medicare and/or Medicaid certified areas within a facility): 206
Beds - Nursing facility (Number of Medicaid certified skilled nursing care beds in a facility): 104
Lpn/lvn - Full time (The number of full-time equivalent licensed practical/ vocational nurses employed by a facility on a full time basis): 15.36
Registered nurse - Full time (The number of full-time equivalent registered nurses employed by a facility on a full time basis): 6.69
Compliance: life safety code (Indicates if a waiver of the life safety code has been recommended for a provider): WAIVER RECOMMENDED
Program participation (Indicates if the provider participates in Medicare, Medicaid, or both programs): MEDICARE AND MEDICAID
Regional override #1 (number beds) (This field is set to "y" when the regional office has to ok a pending record in the special fields screen. this field only applies to categories in the odie data entry system): Yes
Regional override #2 (staffing) (This field is set to "y" when the regional office has to ok a pending record in the special fields screen. this field only applies to categories in the odie data entry system): Yes
Activity professional - Full time (The number of full-time equivalent activities professionals employed full time by a facility): 1.07
Administrator - Full time (The number of full-time equivalent administrative staff employed on a full time basis by a facility): 14.16
Administrator - Part time (The number of full-time equivalent administrative staff employed on a part-time basis by a facility): 2.10
Beds - Snf/nf (Number of beds certified for both Medicare and Medicaid skilled nursing care in a long term care facility): 102
Cert nurse aides - Contract (The number of full-time equivalent certified nurse aides under contract to a facility): 6.76
Cert nurse aides - Full time (The number of full-time equivalent certified nurse aides employed by a facility on a full time basis): 47.57
Cert nurse aides - Part time (The number of full-time equivalent certified nurse aides employed by a facility on a part time basis): 24.70
Dentists - Contract (The number of full-time equivalent dentists under contract to a facility): 0.36
Dietitians - Part time (The number of full-time equivalent dietitians employed by a facility on a part time basis): 0.86
Food service - Full time (The number of full-time equivalent food service personnel employed by a facility on a full time basis): 10.23
Food service - Part time (The number of full-time equivalent food service personnel employed by a facility on a part time basis): 12.64
Housekeeping - Full time (The number of full-time equivalent housekeeping personnel employed by a facility on a full time basis): 20.61
Housekeeping - Part time (The number of full-time equivalent housekeeping personnel employed by a facility on a part time basis): 5.27
Lpn/lvn - Contract (The number of full-time equivalent licensed practical/ vocational nurses under contract to a facility): 9.46
Lpn/lvn - Part time (The number of full-time equivalent licensed practical/ vocational nurses employed by a facility on a part time basis): 6.21
Medical director - Contract (The number of full-time equivalent medical directors under contrcat to a facility): 0.11
Mental health services - Contract (The number of full-time equivalent mental health services personnel under contract to a facility): 0.71
Nurses with admin duties-Full time (The number of full-time equivalent nurses with administrative duties employed by a facility on a full time basis): 2.09
Occup therapy asst - Contract (The number of full time equivalent occupational therapy assistants under contrcat to a facility): 0.73
Occupational therapist - Contract (The number of full-time equivalent occupational therapists under contract to a facility): 0.54
Organized resident group (Indicates if the facility has an organized residents group): Yes
Other - Full time (The number of full-time equivalent persons not included in any other categories employed by the facility on a full-time basis): 10.74
Other - Part time (The number of full-time equivalent persons not included in any other categories employed by the facility on a part-time basis): 3.47
Other activities staff-Full time (Number of full-time staff hours for other activities): 3.23
Other activities staff-Part time (Number of part time staff hours provided by other activ ities staff): 1.49
Other physician - Contract (The number of full-time equivalent other physicians under contract to a facility): 0.11
Pharmacists - Contract (The number of full-time equivalent pharmacists under contract to a facility): 0.23
Phys ther asst - Contract (Number of contract staff hours for physical therapy ass istants): 1.01
Physical therapists - Contract (The number of full-time equivalent physical therapists under contract to a facility): 0.49
Physical therapy aide - Contract (The number of full-time equivalent physical therapy aide under contract to a facility): 0.83
Registered nurse - Part time (The number of full-time equivalent registered nurses employed by a facility on a part time basis): 2.70
Rn director of nursing - Full time (The number of full-time equivalent rn director of nursing employed by a facility on a full time basis): 1.13
Social worker - Full time (The number of full-time equivalent social workers employed by a facility on a full time basis): 2.76
Speech pathologist - Contract (The number of full-time equivalent speech pathologists under contract to a facility): 0.50
Compliance: status (Indicates if a provider or supplier is in compliance with program requirements): IN COMPLIANCE
Current survey date (The date of the health or life safety code survey, whichever is later. the "official" survey date for the provider): Oct 2002
Eligibility code (Indicates if a facility is eligible to participate in the Medicare and/or Medicaid programs): ELIGIBLE TO PARTICIPATE
Participation date (The date a facility is first approved to provide Medicare and/or Medicaid services): Mar 1978